Fioretto J R, Bonatto R C, Ricchetti S M, Carpi M F, de Moraes M A, Padovani C R
Department of Pediatrics, São Paulo State University, Botucatu Medical School, Brazil.
Croat Med J. 2001 Oct;42(5):527-34.
To establish a protocol for the early introduction of inhaled nitric oxide (iNO) therapy in children with acute respiratory distress syndrome (ARDS) and to assess its acute and sustained effects on oxygenation and ventilator settings.
Ten children with ARDS, aged 1 to 132 months (median, 11 months), with arterial saturation of oxygen <88% while receiving a fraction of inspired oxygen (FiO2) >or=0.6 and a positive end-expiratory pressure of >or=10 cm H2O were included in the study. The acute response to iNO was assessed in a 4-hour dose-response test, and positive response was defined as an increase in the PaO2/FiO2 ratio of 10 mm Hg above baseline values. Conventional therapy was not changed during the test. In the following days, patients who had shown positive response continued to receive the lowest iNO dose. Hemodynamics, PaO2/FiO2, oxygenation index, gas exchange, and methemoglobin levels were obtained when needed. Inhaled nitric oxide withdrawal followed predetermined rules.
At the end of the 4-hour test, all the children showed significant improvement in the PaO2/FiO2 ratio (63.6%) and the oxygenation index (44.9%) compared with the baseline values. Prolonged treatment was associated with improvement in oxygenation, so that FiO2 and peak inspiratory pressure could be quickly and significantly reduced. No toxicity from methemoglobin or nitrogen dioxide was observed.
Administration of iNO to children is safe. iNO causes rapid and sustained improvement in oxygenation without adverse effects. Ventilator settings can safely be reduced during iNO treatment.
建立急性呼吸窘迫综合征（ARDS）患儿早期吸入一氧化氮（iNO）治疗方案，并评估其对氧合及呼吸机设置的急性和持续影响。
本研究纳入10例ARDS患儿，年龄1至132个月（中位数11个月），在吸入氧分数（FiO2）≥0.6且呼气末正压≥10 cmH2O时动脉血氧饱和度<88%。在4小时剂量反应试验中评估iNO的急性反应，阳性反应定义为动脉血氧分压/吸入氧分数（PaO2/FiO2）比值较基线值升高10 mmHg。试验期间常规治疗不变。在接下来的几天里，显示阳性反应的患者继续接受最低剂量的iNO治疗。根据需要获取血流动力学、PaO2/FiO2、氧合指数、气体交换和高铁血红蛋白水平。吸入一氧化氮撤药遵循预定规则。
4小时试验结束时，所有患儿的PaO2/FiO2比值（63.6%）和氧合指数（44.9%）较基线值均有显著改善。延长治疗与氧合改善相关，从而可快速且显著降低FiO2和吸气峰压。未观察到高铁血红蛋白或二氧化氮的毒性。
对儿童给予iNO治疗是安全的。iNO可使氧合迅速且持续改善，无不良反应。在iNO治疗期间可安全降低呼吸机设置。
